Impact of prone position on outcomes of COVID-19 patients with spontaneous breathing (original) (raw)
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Prone position in wards for spontaneous breathing Covid-19 patients: a retrospective study
Irish Journal of Medical Science (1971 -)
The pandemic of coronavirus disease 2019 (Covid-19) caused a large number of non-ventilated hypoxemic patients to require the use of prone position. The aim of this study is to measure the efficiency and tolerance of prone positioning in ward hypoxemic patients treated for Covid-19. This retrospective study included confirmed Covid-19 hypoxemic patients treated by at least one prone position session. Primary outcome was pulse oximetry over inspired oxygen fraction ratio (SpO 2 /FiO 2) before, during, and after prone position. Secondary outcomes were failure, adverse events, and poor tolerance rate. Twenty-seven patients were included. During first, second and third sessions, SpO 2 /FiO 2 ratio was significantly higher during posture than before (p < 0.0001, p < 0.01, and p < 0.001 respectively). Eighteen patients were responders (defined as an improvement of SpO 2 /FiO 2 of more than 50) during the first posture and have a shorter length of hospital stay than non-responder patients. Failure rate was 5%, and poor tolerance and adverse events rates were 8% and 7% respectively. Our study found that prone position in wards improved alveolar exchange during posture and is well tolerated. This technique could be used in any medical ward.
A REVIEW OF THE PRONE POSITION IN ACUTE RESPIRATORY FAILURE DUE TO COVID-19 (Atena Editora)
A REVIEW OF THE PRONE POSITION IN ACUTE RESPIRATORY FAILURE DUE TO COVID-19 (Atena Editora), 2023
To improve oxygenation, the prone position is indicated in acute respiratory distress syndrome, being used in critically ill patients. The use of prone position improves the hypoxemic level and reduces mortality when used early. The objective is to identify the indication and main benefits and complications of the prone position in patients admitted to the Intensive Care Unit under mechanical ventilation due to acute respiratory failure due to Covid-19. This is a narrative review of the literature carried out in August 2022, in the Scielo, PubMed and ``Portal de Periódicos Capes`` databases on the clinical indication, benefits and complications of the prone position in patients under mechanical ventilation due to acute respiratory failure due to Covid-19. 19, admitted to the Intensive Care Unit. The Health Sciences descriptors used were “Intensive Care Unit”, “Covid-19” and “Prone” (prone position), using the Boolean operator “AND”. The original publications were established as inclusion criteria, available in full in Portuguese, English and Spanish, published from 2020 to 2022. As it is a literature review, the study did not require approval from the ethics committee. They resulted in 14 scientific articles, eight from Capes and six from PubMed. Benefits were reported by seven articles, complications by two, and five dealt with the two themes (benefits and complications). Although this review did not make it possible to define the indications for the use of the prone position, some benefits pointed out were the improvement in the PaO2/FiO2 ratio, oxygenation, reduction in length of stay and mortality, and better lung compliance. With regard to complications, pressure injuries and accidental removal of medical devices such as an endotracheal tube and peripheral and central venous accesses occur. Finally, prone positioning was used in intubated and non-intubated patients, with significant PaO2/FiO2 improvements in prone patients during the Covid-19 pandemic. The limitation in this review is that there is heterogeneity in the studies regarding the pronation criteria, its definition, use, benefits and complications, with cohort methods, cross-sectional studies and with casuistic interventions. Although the pandemic has already ended, retrospective studies are suggested to better investigate the conduct of pronation in patients with Covid-19 in intensive care.
Pakistan Armed Forces Medical Journal
Objective: To evaluate the effectiveness of awake proning on bedside oxygen saturation in non-intubated severe COVID-19 cases and its association with high-resolution CT chest severity score. Study Design: Prospective observational study. Place and Duration of Study: Pak Emirates Military Hospital Pakistan, from Jun to Jul 2020. Methodology: This study was conducted on 150 laboratories confirmed SARS-CoV-2 infected cases with moderate to severe category pneumonia, requiring supplemental oxygen but not mechanical ventilation, admitted in the High Dependency Unit of the Military Hospital. Bedside oxygen saturation was recorded via pulse oximeter before and after proning of 10 minutes to evaluate whether oxygen saturation increased, decreased or remained the same post proning. Results: Out of 150 patients, it was observed that 67 (45%) patients showed 2% increase of oxygen saturation over 10 minutes of proning, 48 (32%) patients showed an increase of 1% while 20 (13%) patients showed a...
Prone Position in Mechanically Ventilated COVID-19 Patients: A Multicenter Study
Journal of Clinical Medicine, 2021
Background: The prone position (PP) is increasingly used in mechanically ventilated coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) patients. However, studies investigating the influence of the PP are currently lacking in these patients. This is the first study to investigate the influence of the PP on the oxygenation and decarboxylation in COVID-19 patients. Methods: A prospective bicentric study design was used, and in mechanically ventilated COVID-19 patients, PP was indicated from a partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FIO2) ratio of <200. Patients were left prone for 16 h each. Pressure levels, FIO2, were adjusted to ensure a PaO2 greater than 60 mmHg. Blood gas analyses were performed before (baseline 0.5 h), during (1/2/5.5/9.5/13 h), and after being in the PP (1 h), the circulatory/ventilation parameters were continuously monitored, and lung compliance (LC) was roughly calculated. Responders were d...
Annals of Intensive Care
Background Prone positioning (PP) has been used to improve oxygenation in patients affected by the SARS-CoV-2 disease (COVID-19). Several mechanisms, including lung recruitment and better lung ventilation/perfusion matching, make a relevant rational for using PP. However, not all patients maintain the oxygenation improvement after returning to supine position. Nevertheless, no evidence exists that a sustained oxygenation response after PP is associated to outcome in mechanically ventilated COVID-19 patients. We analyzed data from 191 patients affected by COVID-19-related acute respiratory distress syndrome undergoing PP for clinical reasons. Clinical history, severity scores and respiratory mechanics were analyzed. Patients were classified as responders (≥ median PaO2/FiO2 variation) or non-responders (
Critical Care
Background Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. Methods Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced du...
Respiratory Parameters of COVID-19 Patients After the Prone Position
Nursing Current: Jurnal Keperawatan, 2021
Hypoxemia is a condition when there is a lack of oxygen levels in the blood, especially from the arteries. In the early stages of COVID-19, several mechanisms such as intrapulmonary shunting, loss of pulmonary perfusion regulation, intravascular micro thrombus, and impaired diffusion capacity can contribute to the development of arterial hypoxemia, although there is no increase in respiratory work. The prone position is one of the most widely used therapies for patients with hypoxemia because the dorsal area has a large number of alveolar units that are not compressed by the weight of the abdominal cavity and mediastinum, thus creating a more efficient area for gas exchange. This study aimed to determine the effect of the prone position on changes in respiratory parameters of COVID-19 patients. This study used the descriptive correlation method on 27 respondents with purposive sampling. Each respondent was given a prone position for three hours and being observed before, during the ...
Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects With COVID-19
Respiratory Care, 2021
BACKGROUND: Awake prone positioning (APP) has been recently proposed as an adjunctive treatment for non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to improve oxygenation and reduce the risk of intubation. However, the magnitude of the effect of APP on clinical outcomes in these patients remains uncertain. We performed a comparative systematic review and meta-analysis to evaluate the effectiveness of APP to improve the clinical outcomes in non-intubated subjects with COVID-19. METHODS: The primary outcomes were the need for endotracheal intubation and mortality. The secondary outcome was hospital length of stay. Pooled risk ratio (RR) and mean difference with the corresponding 95% CI were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of 14 studies (5 randomized controlled trials [RCTs] and 9 observational studies) involving 3,324 subjects (1,495 received APP and 1,829 did not) were included. There was a significant reduction in the mortality rate in APP group compared to control (RR 0.68 [95% CI 0.51-0.90]; P 5 .008, I 2 5 52%) with no significant effect on intubation (RR 0.85 [95% CI 0.66-1.08]; P 5 .17, I 2 5 63%) or hospital length of stay (mean difference 23.09 d [95% CI210.14-3.96]; P 5 .39, I 2 5 97%). Subgroup analysis of RCTs showed significant reduction in intubation rate (RR 0.83 [95% CI 0.72-0.97]; P 5 .02, I 2 5 0%). CONCLUSIONS: APP has the potential to reduce the in-hospital mortality rate in COVID-19 subjects with hypoxemia without a significant effect on the need for intubation or length of hospital stay. However, there was a significant decrease in the need for intubation on subgroup analysis of RCTs. More large-scale trials with a standardized protocol for prone positioning are needed to better evaluate its effectiveness in this select population.
European Journal of Medical Research, 2024
Background Prone positioning (PP) is a low-cost method with minimal risk to the patient that improves the oxygenation of patients with acute hypoxic respiratory failure (AHRF) due to COVID-19 pneumonia, thereby reducing their need for tracheal intubation (TI) and transferring to the intensive care unit (ICU). We aimed to overview the results of all previous systematic reviews and meta-analyses to examine the net effect of PP on oxygenation, the rate of TI and mortality in COVID-19 patients. Methods We searched PubMed, Scopus, Web of Science, Google Scholar, and Cochrane Library databases from December 2019 through 2022 without publication language restriction for systematic reviews and meta-analysis studies on PP vs. supine position (SP) in conscious patients with hypoxic respiratory failure COVID-19. After study selection, data were extracted from published meta-analyses and pooled by comprehensive meta-analysis (CMA) software version 2.2.064 to achieve effect sizes. They were analyzed for TI and mortality rates dichotomous variables, and the results were shown as pooled odds ratios (OR) with a 95% confidence interval (CI). Continuous variables such as oxygenation indices (PaO2/FiO2 and SpO2) were also analyzed, and the data were shown as mean differences (MD) with lower and upper CI. The level of statistical significance was set at p ≤ 0.05. Results Twelve systematic reviews and meta-analyses with 19,651 patients and six systematic reviews with 2,911 patients were included in this Review of Reviews (total: 22,562). PP treatment significantly reduced the rate of TI (OR = 0.639, %95 CI (0.492, 0.829); P-value = 0.001) and decreased mortality (OR = 0.363, %95 CI (0.240, 0.549), P-value < 0.001). There was no difference in PaO2/FiO2 (MD = 3.591[− 40.881, 48.062]; P-value = 0.874) and SpO2 percent (MD = 1.641[− 4.441, 7.723]; P-value = 0.597). Conclusion Prone positioning can be recommended in conscious ICU patients with COVID-19 pneumonia to reduce mortality and intubation.
Journal of Clinical Medicine, 2021
Hypoxemia of the acute respiratory distress syndrome can be reduced by turning patients prone. Prone positioning (PP) is labor intensive, risks unplanned tracheal extubation, and can result in facial tissue injury. We retrospectively examined prolonged, repeated, and early versus later PP for 20 patients with COVID-19 respiratory failure. Blood gases and ventilator settings were collected before PP, at 1, 7, 12, 24, 32, and 39 h after PP, and 7 h after completion of PP. Analysis of variance was used for comparisons with baseline values at supine positions before turning prone. PP for >39 h maintained PaO2/FiO2 (P/F) ratios when turned supine; the P/F decrease at 7 h was not significant from the initial values when turned supine. Patients turned prone a second time, when again turned supine at 7 h, had significant decreased P/F. When PP started for an initial P/F ≤ 150 versus P/F > 150, the P/F increased throughout the PP and upon return to supine. Our results show that a singl...